Application

MUNICIPAL FINANCING APPLICATION
Legal Name of Borrower

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.
Federal ID Number
Website
if applicable

Person(s) to Contact for Clarification Regarding Project
Name

First NameLast Name
Title
Phone Number
Please enter a valid phone number.
Email
example@example.com
Fax Number
Please enter a valid fax number.
Name

First NameLast Name
Title
Phone Number
Please enter a valid phone number.
Email
example@example.com
Fax Number
Please enter a valid fax number.

Obligations/Economics
Are the Applicant's obligations bank qualified?

Bank QualifiedNon-Bank Qualified
Please list the Applicant's current underlying bond rating from the rating agencies listed below (if applicable):
Moody's Investor Service
Standard & Poor's
Fitch
Discuss Applicant's current underlying bond rating from the rating agencies listed below (if applicable):
Has the Applicant ever defaulted or non-appropriated on an obligation?

YesNo
Educational Applicants Only
Enrollment
Enrollment Trend

IncreasingDecreasing
How many schools make up the disctrict? (Please list the number and type of each school)
Elementary
Middle
High School
Other

Essential Use Form
Description of Equipment Purchase
Please be specific and attach any applicable equipment lists or invoices available.

Cancelof
Estimated Equipment Delivery Date

MonthDayYear
Date
Is the Equipment replacing existing Equipment?

YesNo
Payments and Insurance
Will the payments be made from Applicant’s General Fund?

YesNo
Is this transaction being paid for by a government entity?

YesNo
Will any Federal Grant or Loan monies be used?

YesNo
Insurance Information
Liability Coverage
Property Damage Coverage
Deductible

Terms and Conditions
The undersigned hereby authorizes Mercedes-Benz Financial Services USA LLC, its successors, transferees and assigns (“Creditor”) to make inquiry into, to request, and to receive any information concerning information from other creditors which Creditor deems relevant for the potential granting of the proposed borrowing. This authorization shall be effective from the date upon which this agreement is signed and is extinguished automatically upon full payment of the present borrowing. I hereby authorize Creditor and/or the selling dealer (“Dealer”) to make inquiry into, to request, and to receive any information concerning my financial condition, including, but not limited to, obtaining a credit report and contacting any current or former creditors of Borrower(s) to verify any information contained herein or received in connection with this application, which Creditor and/or Dealer deems relevant to the possible extension of credit to Borrower(s) (“Information”). I also grant any such creditors permission to release Information to Creditor and/or Dealer. I authorize Creditor to disclose Information to any of its affiliates, assigns or agents.
Total Cost of Equipment
Down Payment
Amount to Finance
Terms
In Years
Frequency

AnnualSemi-AnnualQuarterlyMonthly
Estimated Delivery Date

MonthDayYear
Date
Remittance

AdvanceArrears
Signature

Clear
Today's Date

MonthDayYear
Date

References

Applicable on transactions less than $500,000.
Bank Name
Account Number
Contact Name
Phone Number
Please enter a valid phone number.
Bank Name
Account Number
Contact Name
Phone Number
Please enter a valid phone number.
Creditor Name
Account Number
Contact Name
Phone Number
Please enter a valid phone number.
Creditor Name
Account Number
Contact Name
Phone Number
Please enter a valid phone number.
Should be Empty: